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Claims Program Manager

Under general direction, the Claims Program Manager plans, directs, organizes, coordinates and supervises the Claims unit of VTA with responsibility over the functions of Workers’ Compensation, liability, and other claims, as well as other programs as assigned.

The Division of Workers’ Compensation (DWC) monitors the administration of workers’ compensation claims, and provides administrative and judicial services to assist in resolving disputes that arise in connection with claims for workers’ compensation benefits. DWC’s mission is to minimize the adverse impact of work-related injuries on California employees and employers.

The Executive Medical Director (EMD) directs the Medical Unit within the DWC to perform a variety of services related to delivery of medical benefits in the workers’ compensation system. The Medical Unit establishes policy and guidelines for the treatment and evaluation of injured workers. The unit examines and appoints physicians to be qualified medical evaluators (QMEs), who in turn examine injured workers to help determine the level of benefits they receive. It also certifies and oversees groups — medical provider networks (MPNs) and health care organizations (HCOs) — that provide care to injured workers. The unit reviews utilization review (UR) plans and handles UR complaints and investigations jointly with the Audit Unit. It also assists the DWC administrative director with other issues affecting providers in the workers’ compensation system, such as setting medical fee schedules, and undertakes medical care studies. The unit also manages the independent medical review (IMR) and independent bill review programs, which resolves disputes about the medical treatment of injured employees and medical-legal billing disputes.

POSITION DESCRIPTION: The EMD develops and coordinates policy and administers the Medical Unit programs which will expedite the delivery of benefits to injured workers through a formalized medical-legal process involving State certified medical examiners and State certified medical evaluators. The EMD, subject to the approval of the Administrative Director, performs all duties, exercises all powers and jurisdiction, assumes and discharges all responsibilities, and carries out and effects all purposes vested by law in the Division of Workers’ Compensation, Medical Unit, except as otherwise expressly provided by the Labor Code. The EMD is responsible for the creation and management of the Medical Evidence Evaluation Advisory Committee. The incumbent plans, organizes, and directs, the work of the Medical Unit, advises and assists the Medical Unit in the promulgation of rules, regulations, and standards; in the adoption of policies and procedures; in the development and implementation of processes and programs; in the preparation, drafting, and publishing of official forms and documents necessary to meet its statutory obligations. The EMD has the legal authority to employ medical assistants and other necessary staff. The incumbent has the legal responsibility to assign panels of qualified medical evaluators; to review the quality and timeliness of evaluations and reports prepared by agree medical examiners and qualified medical evaluators; to grant or deny employer of employee requests to direct agreed medical examiners and qualified medical evaluators to consult with additional physicians. The Medical Unit’s programs are conducted through a legal unit, and an administrative unit, which provide support to the EMD.

DESIRABLE QUALFICIATIONS:• M.D./D.O. and possession of a valid California physician’s and surgeon’s license .
• Experience in occupational health and industrial medicine.
• Ability to communicate quickly and effectively by written and oral communications with the DIR Director, DWC Administrative Director, DWC management and Medical Unit staff, other state departments and agencies, the Legislature, and stakeholders and their respective peers.
• Administrative experience including but not limited to the ability to prepare, understand, and work with a government budget, develop regulations, rulemaking, policy development and implementation.
• Executive management experience, with responsibility for development, execution, and evaluation of major programs, policies and staff development.

STATEMENT OF QUALIFICATIONS:

In addition to a standard state application and resume/CV, all interested applicants are required to submit a Statement of Qualifications with specific information, including work related examples on how his/her background, knowledge, skills, and abilities meet the desirable qualifications and the general qualifications. The Statement of Qualifications must discuss the following critical factors:
• Developing and implementing program goals, objectives, and strategic plans.
• Managing multi-disciplinary teams to achieve a defined objective.
• Leading and developing broad program goals.
• Drafting policies, rules, regulations or legislation.
• Setting performance standards or objectives.
• Personnel matters such as hiring, dismissal, and performance evaluations.
• Any special qualifications or experience which qualifies you for this position.

When completing the Statement of Qualifications, these formatting guidelines must be followed:
• Responses must be typed, single-spaced with a font equivalent to 10-point size Arial.
• Document margins must be one inch on all sides.
• In the upper right-hand corner of each page, list your full name and the date.
• Statement of Qualification must not exceed three pages in length.

Statement of Qualifications that do not conform to the specifications above may be disqualified.

ADDITIONAL INFORMATION:

All applications will be screened and only the most qualified candidates will be scheduled for an interview. Travel expenses incurred to attend interviews are the sole responsibility of each candidate.

HOW TO APPLY:Individuals interested in applying for this position should submit the following:
• Standard state application STD 678
• Maximum three page statement of qualifications describing how the candidate’s experience and education satisfy the desired qualifications
• Current resume or CVApplications will be accepted until the position is filled. Submit all documents and any questions to:
Denise Vargas
Department of Industrial Relations
Division of Workers’ Compensation
1515 Clay Street, 17th Floor
Oakland, CA 94612dvargas@dir.ca.gov

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